79例完全无管化机器人纵隔肿物切除术的回顾性分析研究
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摘要
目的分析达芬奇机器人纵隔肿物切除手术完全无管化(totally no tube,TNT)的可行性及其对加速康复外科的重要意义。方法纳入2016年1月至2017年12月期间在沈阳军区总医院行TNT机器人纵隔肿物切除手术的患者79例,作为TNT组;纳入2014年1月至2017年12月期间在沈阳军区总医院行普通机器人纵隔肿物切除手术的患者35例,同期行胸腔镜纵隔肿物切除手术的患者54例,分别作为非TNT组和电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)组。回顾性分析三组患者的肌肉松弛-气管插管/喉罩时间、手术时间、术中出血量、术后重症监护时间、术后住院时间、术后疼痛视觉模拟评分(visual analogue scale,VAS)、住院费用及术后并发症等相关指标。结果 168例患者手术皆成功完成,无中转开胸、围手术期无严重并发症(共9例患者出现术后并发症)及死亡患者,所有患者顺利出院。TNT组与非TNT组对比,肌肉松弛-气管插管/喉罩时间、手术时间、术中出血量、术后次日VAS疼痛评分、重症监护时间、术后住院时间方面TNT组均明显短于或少于非TNT组(P<0.01);两组住院总费用差异无统计学意义(P>0.05)。非TNT组与VATS组相比,肌肉松弛-气管插管时间、手术时间、重症监护时间差异无统计学意义(P>0.05);在术中出血量、术后次日VAS疼痛评分、术后连续3 d胸腔引流量、术后带管时间、术后住院时间方面非TNT组优于VATS组(P<0.05),但非TNT组住院费用明显较高(P=0.000)。结论达芬奇机器人用于治疗纵隔肿物与胸腔镜手术相比安全性相当,在机器人手术基础上行TNT也是安全可靠的,具有更好的舒适度、疼痛更轻,重症监护及住院时间更短等优势,患者能更快恢复。
Objective To analyze the feasibility of totally no tube(TNT) in da Vinci robotic mediastinal mass surgery and its significance for fast track surgery. Methods A total of 79 patients receiving robotic mediastinal TNT surgery in the General Hospital of Shenyang Military Command from January 2016 to December 2017 were enrolled as a TNT group; 35 patients receiving robotic mediastinal surgery in General Hospital of Shenyang Military Command from January 2014 to December 2017 and 54 patients receiving thoracoscopic mediastinal surgery during the same period were enrolled as a non-TNT group and a video-assisted thoracoscopic surgery(VATS) group. The muscle relaxation and tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, postoperative ICU stay,postoperative hospital stay, postoperative visual analogue scale(VAS), hospitalization costs and postoperative complications and other related indicators were retrospectively analyzed among the three groups. Results Surgeries were successfully completed in 168 patients with no transfer to thoracotomy, serious complications(postoperative complications in 9 patients) or death during the perioperative period. All patients were discharged. Compared with the non-TNT group, the TNT group had significantly less muscle relaxation-tracheal intubation/laryngeal masking time,operation time, intraoperative blood loss, VAS pain score, ICU stay, postoperative hospital stay(P<0.01); there was no significant difference in the total cost of hospitalization between the two groups(P>0.05). Between the non-TNT group and the VATS group, there was no significant difference in time of muscle relaxation and tracheal intubation, operation time and ICU stay(P>0.05). The non-TNT group was superior to the VATS group in terms of intraoperative blood loss,VAS pain scores on the following day after operation, chest drainage volume 1-3 days postoperatively, postoperative catheterization time and postoperative hospital stay(P<0.05); but the cost of hospitalization in the non-TNT group was significantly higher(P=0.000). Conclusion The da Vinci robot is safe and feasible for the treatment of mediastinal masses. At the same time, TNT is also safe and reliable on the basis of robotic surgery which has many advantages such as better comfort, less pain, ICU stay and hospital stay as well as faster recovery.
Objective To analyze the feasibility of totally no tube(TNT) in da Vinci robotic mediastinal mass surgery and its significance for fast track surgery. Methods A total of 79 patients receiving robotic mediastinal TNT surgery in the General Hospital of Shenyang Military Command from January 2016 to December 2017 were enrolled as a TNT group; 35 patients receiving robotic mediastinal surgery in General Hospital of Shenyang Military Command from January 2014 to December 2017 and 54 patients receiving thoracoscopic mediastinal surgery during the same period were enrolled as a non-TNT group and a video-assisted thoracoscopic surgery(VATS) group. The muscle relaxation and tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, postoperative ICU stay,postoperative hospital stay, postoperative visual analogue scale(VAS), hospitalization costs and postoperative complications and other related indicators were retrospectively analyzed among the three groups. Results Surgeries were successfully completed in 168 patients with no transfer to thoracotomy, serious complications(postoperative complications in 9 patients) or death during the perioperative period. All patients were discharged. Compared with the non-TNT group, the TNT group had significantly less muscle relaxation-tracheal intubation/laryngeal masking time,operation time, intraoperative blood loss, VAS pain score, ICU stay, postoperative hospital stay(P<0.01); there was no significant difference in the total cost of hospitalization between the two groups(P>0.05). Between the non-TNT group and the VATS group, there was no significant difference in time of muscle relaxation and tracheal intubation, operation time and ICU stay(P>0.05). The non-TNT group was superior to the VATS group in terms of intraoperative blood loss,VAS pain scores on the following day after operation, chest drainage volume 1-3 days postoperatively, postoperative catheterization time and postoperative hospital stay(P<0.05); but the cost of hospitalization in the non-TNT group was significantly higher(P=0.000). Conclusion The da Vinci robot is safe and feasible for the treatment of mediastinal masses. At the same time, TNT is also safe and reliable on the basis of robotic surgery which has many advantages such as better comfort, less pain, ICU stay and hospital stay as well as faster recovery.
引文
1 Kajiwara N, Taira M, Yoshida K, et al. Early experience using the da Vinci Surgical System for the treatment of mediastinal tumors.Gen Thorac Cardiovasc Surg, 2011, 59(10):693-698.
2 Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the da Vinci Surgical System for patients with myasthenia gravis. Surg Today, 2018, 48(2):195-199.
3 方文涛,谷志涛,陈克能,等.胸腺肿瘤微创手术研究进展.中国肺癌杂志, 2018, 21(4):269-272.
4 王述民,李博,许世广,等.达芬奇机器人在胸腺扩大切除术治疗Ⅰ型重症肌无力的应用.中国胸心血管外科临床杂志, 2013,20(6):679-682.
5 代锋,许世广,徐惟,等.达芬奇机器人与电视胸腔镜辅助非小细胞肺癌根治术近期疗效配对的病例对照研究.中国肺癌杂志,2018, 21(3):206-211.
6 Zhao Y, Jiao W, Ren X, et al. Left lower lobe sleeve lobectomy for lung cancer using the Da Vinci surgical system. J Cardiothorac Surg, 2016, 11(1):59.
7 Kim ER, Lim C, Kim DJ, et al. Robot-assisted cardiac surgery using the da vinci surgical system:a single center experience. Korean J Thorac Cardiovasc Surg, 2015, 48(2):99-104.
8 Miyazaki T, Sakai T, Yamasaki N, et al. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery. Gen Thorac Cardiovasc Surg, 2014, 62(1):58-63.
9 Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4):820-822.
10 刘星池,许世广,徐惟,等.完全无管化达芬奇机器人纵隔肿瘤切除手术在快速康复外科中应用.临床军医杂志, 2016, 44(6):569-570.
11 Tang C, Chai X, Kang F, et al. I-gel laryngeal mask airway combined with tracheal intubation attenuate systemic stress response in patients undergoing posterior fossa surgery. Mediators Inflamm, 2015, 2015:965925.
12 Chauhan G, Nayar P, Seth A, et al. Comparison of clinical performance of the I-gel with LMA proseal. J Anaesthesiol Clin Pharmacol, 2013, 29(1):56-60.
2 Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the da Vinci Surgical System for patients with myasthenia gravis. Surg Today, 2018, 48(2):195-199.
3 方文涛,谷志涛,陈克能,等.胸腺肿瘤微创手术研究进展.中国肺癌杂志, 2018, 21(4):269-272.
4 王述民,李博,许世广,等.达芬奇机器人在胸腺扩大切除术治疗Ⅰ型重症肌无力的应用.中国胸心血管外科临床杂志, 2013,20(6):679-682.
5 代锋,许世广,徐惟,等.达芬奇机器人与电视胸腔镜辅助非小细胞肺癌根治术近期疗效配对的病例对照研究.中国肺癌杂志,2018, 21(3):206-211.
6 Zhao Y, Jiao W, Ren X, et al. Left lower lobe sleeve lobectomy for lung cancer using the Da Vinci surgical system. J Cardiothorac Surg, 2016, 11(1):59.
7 Kim ER, Lim C, Kim DJ, et al. Robot-assisted cardiac surgery using the da vinci surgical system:a single center experience. Korean J Thorac Cardiovasc Surg, 2015, 48(2):99-104.
8 Miyazaki T, Sakai T, Yamasaki N, et al. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery. Gen Thorac Cardiovasc Surg, 2014, 62(1):58-63.
9 Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4):820-822.
10 刘星池,许世广,徐惟,等.完全无管化达芬奇机器人纵隔肿瘤切除手术在快速康复外科中应用.临床军医杂志, 2016, 44(6):569-570.
11 Tang C, Chai X, Kang F, et al. I-gel laryngeal mask airway combined with tracheal intubation attenuate systemic stress response in patients undergoing posterior fossa surgery. Mediators Inflamm, 2015, 2015:965925.
12 Chauhan G, Nayar P, Seth A, et al. Comparison of clinical performance of the I-gel with LMA proseal. J Anaesthesiol Clin Pharmacol, 2013, 29(1):56-60.